Acid-suppressive medication use in pregnancy tied to childhood asthma
Use of acid-suppressive medications during pregnancy is associated with an increased risk of developing asthma in the children, a recent meta-analysis of analytical epidemiological studies suggests.
The meta-analysis pooled data from eight cohort, cross-sectional, and case-control studies which included women during preconception and pregnancy as well as their children who were <17 years. [J Allergy Clin Immunol 2016;doi:10.1016/j.jaci.2016.09.046]
Children whose mothers used any acid-suppressive medications while pregnant appeared to have more than 30 percent increased risk of developing childhood asthma (risk ratio, 1.36, 95 percent confidence interval [CI], 1.16–1.61) compared with nonuse.
Specifically, use of H2-receptor antagonists (H2RAs) during pregnancy was associated with 46 percent increase (hazard ratio [HR], 1.46, 95 percent CI, 1.29–1.65) and proton pump inhibitors (PPIs) with 30 percent increase (HR, 1.30, 95 percent CI, 1.07–1.56) in risk of developing childhood asthma.
“It is important to stress that this association does not prove that the medicines caused asthma in these children,” said senior co-author Professor Aziz Sheikh, codirector of the Asthma UK Centre for Applied Research at the University of Edinburgh in Edinburgh, UK.
None of the studies included in the analysis adjusted for all the known confounders in these associations, according to the researchers, who said, “Our findings of increased risk may reflect a true risk or may be explained by residual confounding and/or confounding by indication.”
Additionally, two studies included in the analysis also reported an increased risk of other allergic disorders in children whose mothers used any acid-suppressive medications during pregnancy, although the researchers rated the quality of evidence as “very low” based on the GRADE* approach.
Previous studies have proposed that acid-suppressive medications may disrupt antigen digestion, leading to increased amount of allergen exposed to the foetus, thereby resulting in sensitization and development of asthma and other allergic disorders. [Clin Exp Allergy 2009;39:246-253]
“Although we cannot recommend any changes to the use of acid-suppressive medications by expectant mothers, further research is needed, particularly through mounting pharmacovigilance studies,” suggested Sheikh and co-authors.